Provider Demographics
NPI:1205819521
Name:KAUFMAN, SCOTT (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KAUFMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MILFORD ST STE 605
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6952
Mailing Address - Country:US
Mailing Address - Phone:410-334-2227
Mailing Address - Fax:
Practice Address - Street 1:105 MILFORD ST STE 605
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6952
Practice Address - Country:US
Practice Address - Phone:410-334-2227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001632A207RC0001X
MDH93578207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000496802OtherBLUE CROSS BLUE SHIELD IN
90000561OtherBLUE SHIELD OF IL
P00386217OtherRAILROAD MEDICARE
IN200026070Medicaid
IN200026070Medicaid
659540QMedicare PIN